1. Field of Invention
This invention relates to surgical processes and instrumentation for the repair of a specific type of fracture found in human and animal joints.
2. Discussion of Prior Art
In the field of Orthopaedic surgery, patients frequently present with serious depression fractures of the articulating surfaces in joints. Such trauma is relatively common in the articulating surfaces of the femoral condyles and the tibial plateau. These fractures result from overloading the joint surfaces during falls, automobile accidents, sports play and other high impact situations. The extreme pressures of the impact actually overload the strength of the joint articulating surfaces, causing one joint surface to be driven into the other joint surface; commonly the rounded condyles into the more planar surfaces of the tibial plateau. Here-to-fore, surgeons needed to incise the joint wide open to repair such depression fractures. Even though it has been widely known and accepted to do joint repairs with a minimum of invasion, there was no technique available which was reduced to the combination of a process and a set of specially designed instruments.
Mention of the desirability of an Arthroscopic procedure for reducing depression fractures is found in the medical book xe2x80x9cOrthopaedic Trauma Protocolsxe2x80x9d Eds. Sigvard T. Hansen, Jr. and Marc F. Swiontkowski both of Harborview Medical Center; Publisher, Raven Press, Ltd., New York, N.Y. An additional publication, Technique for Arthroscopic Fracture Management System, a commercial advertising flyer put out in 1995 by Acufex Microsurgical Inc., suggests that using a device called an xe2x80x9cintra-articular guidexe2x80x9d (which is sold by Acufex Microsurgical, and was designed for other procedures) will aid surgeons to reduce intra-articular fragments. This literature does not suggest instruments for remotely manipulating bone fragments, nor does it speak to a process for adjusting the level of the articular surface to make it anatomically correct.
Nowhere in the literature is there mention of a cohesive procedure and/or set of instruments for actually performing an Arthroscopic reduction of an articular depression fracture. Further, nowhere is there the suggestion that a depression fracture may be reduced arthroscopically by a lateral approach.
Accordingly, several objects and advantages of our invention are:
The object of this invention is to provide a process and the required instruments to enable a surgeon to repair depression fractures through an incision only 1 to 2 cm long. This is an Arthroscopic procedure with a minimum of invasion. In addition to the 1 to 2 cm incision in the above sentence, there are typically two more incisions (standard Arthroscopic portals) xc2xd cm long; the second one for the arthroscope and the third for irrigation.
The combined procedure and hardware of this invention allows a skilled surgeon to accomplish an Arthroscopic reduction of an articular surface depression fracture in a joint, with only limited incisions, using a lateral approach. This procedure and instrument system allow a surgeon to affect a reduction of depression fractures, especially those of the central and peripheral tibial plateaus, without opening wide the knee. Further, this technique does not require soft tissue stripping.
The same above mentioned incisions are used again when bone grafting any bone deficit. All necessary bone grafting is performed using the procedure and two of the instruments of this invention.
This procedure and instrument system further allows a surgeon to fixate a loose body fracture fragment. Only one 1 to 2 cm incision and the usual Arthroscopic portals are required, that is, the procedure is performed arthroscopically. Previous surgical techniques required a very extensive incision; opening the entire knee.
This invention saves time. It requires much less time to open and close a 1 to 2 cm incision than a 25 cm incision.
This invention saves trauma. Much less damage is done to soft tissue; muscles and tendons and ligaments need not be resected. This surgery has very minimal invasion. Previous surgical techniques required much greater invasion. Increased scarring and devascularization are associated with extensive invasion.
This invention reduces rehabilitation time. The standard incision, such as cutting a knee wide open, requires that all of the affected tissues be dissected or split. Rehabilitation then requires that all of the affected tissue heal and revascularize. This healing, growing back, is time consuming. The patient is uncomfortable and out of the work force.
This invention may reduce future joint problems. It is widely known that articular surface irregularities lead to early arthritis. In the medical community it is well known and accepted that Arthroscopic surgery is less traumatic to the patient than major invasive open surgery. Less trauma means that there is less rehabilitation.